March 21, 2017

Price transparency for healthcare is not a problem in single-payer

A major concern that people on the Right have raised about fixing the healthcare system is the lack of transparency in pricing.

The drug companies and hospitals don't have a menu posted like they do when you walk into a McDonald's, and if you try to press anyone there for the information, they either do not have it or will refuse to give it to you. Perhaps you'll only find out how much something cost after the fact and they've stuck you with the bill for a $20 cup of orange juice. Then you either pay it, or pay the various costs of fighting off a collection agency, or pay the costs of filing for bankruptcy.

The exact same drug by the same manufacturer in the same quantity may cost orders of magnitude more in America than in another first-world country. We don't know how much it costs here before we get the bill, and we certainly don't know how cheap it is to buy in other countries.

This opacity allows the healthcare providers to drive up prices, just as we've seen over the past several decades.

But is the lack of transparency in pricing a cause or effect of our terrible healthcare system?

The argument on the Right assumes that if we could make prices more transparent to the customer, it would go a long way toward bringing down expenditures. They would now have the information needed to shop around, play competitors off against each other, and so on.

The trouble is that people do not want to even think about prices when it comes to healthcare. Five years or so ago, the libertarian autists at George Mason economics were discussing this aspect of rising healthcare costs. Some of them (Hanson, I think) pointed out that people are in a different mindset when it comes to things like life and death, so they don't apply the same behaviors to navigate their way through healthcare decisions.

If our health is sacred and taboo, especially on the insides of our bodies where we can't really see what's going on, we just aren't going to "go there" and view it like a mundane mechanism. To the human mind, the body is not like a car with its parts and systems, so we aren't going to ask multiple health providers for quotes, ask which provider has the best reputation, haggle about the price, and so on.

It's part of the sacred realm where mechanisms and price haggling are not allowed. So we just accept whatever it costs to get better, and hope it won't cost too much.

Parishioners, sitting in the pews on Sunday morning, are not wondering if the Church scored a killer deal with whatever furniture makers made their pews. They aren't thinking, Is all that money in the collection plate going to waste because the leaders didn't negotiate a good deal on the pews? It's part of the sacred architecture, and is beyond questions of pricing when you're in the worshiping mindset.

So, even when you experimentally give people the kind of information about healthcare that they'd need to shop around, they tend not to make use of it. Those facts, figures, and spreadsheet calculations put them into the profane mindset when they're facing decisions about something sacred like their health.

This will remain a problem as long as the recipient of price information is the end consumer of healthcare. If it's a close friend or relative, it reduces to the same problem. They're too emotionally invested in their loved one's sacred health to even think of getting into the profane haggling mindset.

Single-payer systems solve this problem by making the national health boards the recipient of price information. First as an opening offer, then lowering it through aggressive negotiations by the national board. The board could also demand to see the recent or long-term history of prices for various things -- are prices going up disturbingly quickly?

These board members are in total bean counter and negotiator mode, as they are not the end consumers of healthcare goods and services being considered. Occasionally they'll be using the public system, but not at that moment for those services being examined. This allows them to keep a much cooler and rational mindset while considering prices, and trying to get a better deal from the providers.

It's no different from how those pews got purchased for the Church -- somebody somewhere in the organization looked at how much there was in the budget for pews after the collection plate had been sent around, then they sent out a request for bids to manufacturers, inspected their track record for quality, played them off each other, and negotiated a decent deal. Nobody in the sacred services had to know anything about it -- and would not want to know.

So, relying primarily on a single-payer system not only allows all the isolated little taxpayers to pool their resources and throw their collective weight around at the negotiating table. It also allows them to not make serious financial decisions when they're in sacred mode, where price is no matter, sending it off instead to someone who will be in profane mode.

You could always try to get someone else to haggle on your behalf, while not pooling resources with anyone else to do so. But then you'd have as many hagglers as patients -- why waste all those resources, when it can be consolidated into a specialist team that haggles on behalf of the entire population? Especially when a national haggler can make a more serious threat by walking away, compared to an individual haggler.

Nobody in the first world knows what most of the prices are for their healthcare services -- whether they live in America where they get raped, or in the other rich countries where they do not. Somebody other than the end consumer is thinking about prices, if anyone is at all. So price transparency is not a necessary factor in explaining why our system sucks, and fixing that problem would not be sufficient to deliver good healthcare outcomes at low prices.

The more you look into it, the more reasonable the single-payer system is, whether Canada, Australia, England, France, or wherever.

24 comments:

Single-payer implies that everyone gets the same quality of care and spends the same amount of money. It also sounds like only one person pays for everyone's costs. The phrasing is wrong. Many Americans prefer inequality, even if it hurts them. They would rather have a "Gold plan" to dream about, while receiving "bronze," than have that same top plan without the "Gold" name. I am simplifying, but my point is mostly true, I think. I also think we have bad services because of a labor supply glut. Employers paying for medicine started during WWII, when wartime communism restricted them from increasing wages. It's just a strange, communist policy, which appeals to the American communist sense of bourgeois / workers' rights and privileges. Having the same healthcare plan from the government, not an employer, is seen as immoral because government money is considered tainted by theft and corruption. People here do not ever feel that their employer overpays for their medicine, because it is American to envy employers and dream of owning one's own magical business without hiring anyone. Many fools start businesses this way and fail quickly. Similarly, Americans prefer empowering Aetna to saving their neighbors' financial and medical lives.

When I asked a doctor I know about healthcare funding, he said there's no problem, we're doing ok, costs are not rising too fast, and ObamaCare is good enough. I wonder if tying his salary growth to cost containment would change his mind. At least we agree that hospitals, as monastic institutions from my perspective, should be government and church -owned, not corporate shareholder-owned.

At a recent town hall in my district, the congressman's response to a small business owner asking for clarification on RyanCare's effects was that he's right to be concerned, but Democrats will help him out. I think everyone there believed this.

I think it doesn't make ethical sense for employers to want "to take care of" their workers, based on how that works in Japan. It's charitable workaholism.

The book Deadly Spin: An Insurance Company Insider Speaks Out... is useful. I haven't read it yet, because it's outdated and I'm reading free pdfs instead. But the author explains how healthcare here is kept bad, and references a good charity, RAM- Remote Assistance? Medical.

A big hearty fuck you to Fox News for banishing Andrew Napolitano. I dunno if Trump is going to be calling out Fox any time soon, but regardless, don't waste your time with Fox any more. They're pretend opposition to liberals and globalists at this point. Hannity and Carlson should suck it up, leave the nice paycheck behind, and join Breitbart or start their own outfit. Bah!

We could always use the phrase "national health care" -- no globalist or Hillary connotations of "universal," doesn't have a wonky focus on the funding mechanism like "single-payer," and goes along with the emphasis on nation-states and nationalism.

Also suggests the strength we have to negotiate coverage and prices if it's done at the national level. "Single-payer" doesn't immediately bring to mind a great big single payer.

It's tied to our higher level of ethnic and cultural diversity, which erodes trust and makes us callous not only to The Other but even to the fellow members of our own group. Everyone just hunkers down as isolated individuals. (Robert Putnam's study)

For health care, there's a silver lining in that most of the health care is given to old people -- age 65 and older. In that age group, America still looks like it did 50 years ago -- 85% white, 10% black, 5% misc.

The really apathetic attitudes are found among the more diverse group of late X-ers and Millennials, but then they don't make up much of the electorate, so who cares what they don't want.

Also that diversity is non-existent in the lynchpin states for Trump -- the Midwest outside of Chicago. There's a handful of blacks in this city and that city, no Hispanics, no Asians, just white white white, especially at older ages.

That region already has such a heavy focus on looking out for our own (Michael Moore, Sicko) that they would not need their arms twisted to support national health care. In fact, it would finally put to rest their anxieties about voting for the high-risk choice of Trump.

Even the local urban shitlibs won't be able to go on with the act of dreading Trump. They're already resigned.

I'm not really sure where you're coming from on this to be honest. There is a reason why the Tea Party rallies looked the way they did a few years back... They were almost all white people born in the 1940s to 1970s with college degrees. That is basically the Republican base. The people least likely to support government healthcare coverage, unless you’re talking about “their” Medicare.

Tea Party is not the Trump base. For some of them, Trump was what they'd been waiting for -- for others, Lyin' Ted was it. Trump did not run on anything like a Tea Party platform, during primaries (that would be Lyin' Ted) or the general.

If he did, he would've only appealed to the marginal numbers of hardcore GOP / Conservative Movement types, and lost just as bad as Ted Cruz would have.

Trump won by marginalizing most of the Tea Party issues, and focusing primarily on re-industrialization, by strong tariffs if necessary (very anti-market), and tough immigration (one big issue where the Tea Party agreed).

Tea Party people also tend to be higher income, whereas the new Trump base is working / lower-middle class whites in former blue states. He owes more to them than to Tea Party activists.

Honestly part of the problem as I see it is the older white people that were less selfish and actually remembered FDR are mostly dead by now. The losts, GIs and Silents all had their problems. the last in particular you've done a pretty good job covering the anti social elements of. but they generally seemed more humane, more willing to pitch into make a society that worked for everyone. they had a better idea of what came before the mid 20th century. and what made a lot of the reforms of that period work. we're losing that.

A big issue is the ACA's reference to "Care," not health-care. People don't even want to hear about medicine. Like, what's that? People are vain, and don't like needing or taking medicine, in part because it is so expensive and high-tech, so they think they need something even more expensive and hi-tech, like super-lasers.

My solution is to stop saying health or care. Both have become toxic, associated with illness and theft through unfair pricing. Let go of the bad past, and try..."21st Century Medicine," which could be done with U.S. allies, which is the only way to actually make our medicine more like that *in other countries.* We need them to lead, and they would have already done so, to help us and themselves, if we weren't rejecting aid we need, roping them into the War on Terror, and frightening them that they might have their health-care systems ruined by our terrible model.

"national health care"

Man, I think you're too federally-minded from spending time near D.C. Out West, personally felt and valued nationalism is more about local stuff, like who runs the local General Hospital, and growing up with your pediatrician's own children, and programs like having safe, mildly mentally ill people briefly housed in local residents' homes, not locked wards (Boulder CO, is the only place to ever have this in the 20th century U.S., I think).

Roman Catholics are the specialists in concepts like subsidiarity, besides the tendency among religious people to believe they can just drop out of society's cons, without losing the pros.Here's how that looks, in two recent book reviews: http://www.thepublicdiscourse.com/2017/03/19008/ (larpist Rod Dreher)http://www.thepublicdiscourse.com/2017/03/18900/ ("subsidiarity")

SWPLs, a rising, serious political force, also like their own adopted regions, which are never similar to D.C. or the Heartland, only peripheral areas, mostly the coasts. "National" sounds... like Statefarm, the insurance company. It's uncool, for Millenials, to notice countries even exist. People used to study the world's many flags and capitals, that's how Boomers worldwide were raised, to be the United Nations generation. They gave up on that, probably because American hegemony nixed it, and the Olympics were embroiled in the Cold War, and even marred by terrorism. If we can't even compete in sports together, why know each other's countries?

Americans used to know the 50 state flowers, and all sorts of patriotic, aesthetic and thus IQ-demanding things. That's gone, I think, because of urbanization and IQ falling, not bad education or TV and car culture ruining wildflowers. Also, florists have no lobbyists or TV shows. They don't like receiving status, only enabling its enacting by supplying the material of gifts for holidays and commemorations, which is rare, and disadvantages them in a way. I like florists, except that their bouquets tend to be too big.

Why does anyone invest in Aetna, is what I meant. Why does anyone work in private hospitals, or over-charge medical students for excess education, forcing them to pass on the costs to patients, and so on. The whole medical-economic ecosystem is like a predatory food chain, with little cooperation. It's not just the executives who are greedy. I have also taken issue with my own doctors prescribing things which weren't helpful for me, like inhhalers to treat common colds. The sanctification of sanity, meaning health, is not justified. http://www.etymonline.com/index.php?allowed_in_frame=0&search=sanity

It's sort of considered insane to not maximize health in theory, but actually doing healthy things is seen as insane too. I think an overemphasis on providership is the issue- keeping someone well is "nice."

The most common response to feminist-caused problems is to say everyone needs to be "nice," but in practice, this gentle-respectfulness gospel only applies to straight men. It's not clear which thing is the chicken or egg. I think men feeling like they must compete with technology and gadgets for appreciation, attention, and affection, while women experience no such pressure, is a primary cause. It's difficult to satisfy a woman who has machines do her chores and can afford her own vacations, impossible really, if being needed is essential to being wanted. Men these days often feel women are incapable of loving them, just because women are almost entirely happy remaining comfortably single, at least for so long that it's too late to find a husband later. And no one in politics really discusses sexual economics, so we can't fix healthcare.

"emphasis on nation-states and nationalism"

Then call it Americacare... because plenty of Americans can't answer the question, "name two nations." Nation-state is a complex concept. You forget you're really smart, Agnostic. Most people are way less smart, whether they are patriots or not.

Tea Party people also tend to be higher income"

I think it's high status first, and higher income secondarily. Any 18th century references are high status. Glenn Beck re-wrote Tom Paine's Common Sense pamphlet to take advantage of the Tea Party movement. It's that sort of thing, a symbol or dog-whistle.

Trump owes nothing to Gen-X and Millennials in blue states out West, so who cares what they associate "national" with? They're supposedly the ones most supportive of single-payer anyway, and will either welcome the plan despite not liking the name, or will whine about branding and have no effect on policy.

Trump ran on nationalism, not regionalism. In order to take on the biggest and baddest enemies, whether foreign terrorists, invading hordes, the Chamber of Commerce, or the drug and insurance companies, we need as big and bad of a counterweight as possible. That means national, not regional or local.

In general, it's not a useful guide what your fellow out-West free spirits are thinking. Try to imagine what the people in a Michael Moore documentary are feeling.

"Men these days often feel women are incapable of loving them, just because women are almost entirely happy remaining comfortably single, at least for so long that it's too late to find a husband later."

Your worldview is so warped from living in the Bay Area.

"Then call it Americacare"

Americare is more pronounceable. Or to fuck with libs, call it 'Mericare after Medicare.

For rallying younger voters' support, a successful slogan would be more personal and giving, which is what Millennials want to hear: "your hospital, your doctor, and your money"(even though it's not immediately implementable. It would take tons of capital to buy out all the corporate-investor owned hospitals, without seizing their property with military force, which would offend moderates like me. And many doctors, besides other medical workers, won't want to work in public hospitals, despite their union membership. And the economy needs to pay out decent incomes to most people for most people to afford health care, which will remain expensive, even if costs are controlled and even lowered.)

There could be several slogans, not just one. I also like "Treat Americans Right Act (for the legislation)"; "Treatments and Cures, not his and hers" for post-feminist reform of spending skewing towards women's health, and "Bingo not gringo" for all-American social, recreational familiarity as a kind of palatable, outgroup-free nationalism, because Mexicans can play bingo in Mexico whenever they want. This last one is not specific to healthcare or entitlements and economics. I don't think economic nationalism is wise for us. It might work for Le Pen in France, but we're different. We don't have a socialist history, we don't have the homeland of Marxism and Leninism and the Paris-educated Khmer Rouge, and we're really not interested in depriving anyone of anything, because the basis of Millennial Americanism is abundance gospel,

not prosperity or profit. It's about hanging out somewhere with lots of resources, like grocery store patios instead of real cafes, just because the store sells much more and has more revenue. Whole Foods is now integrating outside businesses into their new stores, to make sort of SWPL-center lifestyle-oriented shopping experiences. It'll work, if they stay on brand and keep prices low enough to not be seen as staying in the passing Gilded phase.

He pressed Sec Price about whether the House plan and/or the administrative and later legislative "phases" would move toward Trump's promise of "universal" coverage. Price dodged all three or so pointed attempts to get an answer, saying that it's our goal for everyone to "have access" without the "government forcing" anyone to have any particular plan.

Tucker also asked if there were other countries' plans they studied before coming up with their plan. Price said Switzerland -- the least single-payer of the first world, where you're required to buy private insurance, but it's not a single-payer through the tax system.

He added that it's tough to do single-payer here because the other countries have more homogeneous populations. I.e., white people don't want to subsidize lardass ghetto blacks.

The worst thing Michael Moore can do for the cause of single-payer is to show blacks as the recipients. Focusing so much on non-whites who are screwed by the system only makes the typical white viewer shrug their shoulders and say, "Not my group, not my problem".

I take Price's answers as a good sign -- if he and/or Trump were truly opposed to single-payer, he would have said "absolutely and categorically no, we're never going to be like Canada, Australia, England, etc. Not even close."

He pressed Sec Price about whether the House plan and/or the administrative and later legislative "phases" would move toward Trump's promise of "universal" coverage. Price dodged all three or so pointed attempts to get an answer, saying that it's our goal for everyone to "have access" without the "government forcing" anyone to have any particular plan.

Tucker also asked if there were other countries' plans they studied before coming up with their plan. Price said Switzerland -- the least single-payer of the first world, where you're required to buy private insurance, but it's not a single-payer through the tax system.

He added that it's tough to do single-payer here because the other countries have more homogeneous populations. I.e., white people don't want to subsidize lardass ghetto blacks.

The worst thing Michael Moore can do for the cause of single-payer is to show blacks as the recipients. Focusing so much on non-whites who are screwed by the system only makes the typical white viewer shrug their shoulders and say, "Not my group, not my problem".

I take Price's answers as a good sign -- if he and/or Trump were truly opposed to single-payer, he would have said "absolutely and categorically no, we're never going to be like Canada, Australia, England, etc. That's SOCIALIZED MEDICINE, which is the first step toward Nazism."

Indeed! I don't expect my high school classmates to have more than 20% total marriage rate in the next 10 years. In their 30s, most will remain, at this sociosexual rate, somewhere between single and casually relationshipping. I also expect them to demand legal prostitution, as feminism fades away. And the transplants who come here are generally hardcore individualists, with very few exceptions who plan on meeting a future spouse here, then settling down in a suburb. The Bay Area's emphatic pride of same-sex marriage is also an impediment to heterosexuality. That's only one of the dozens of reasons marriage and hetero-romance are cockblocked here.

I'm not sure if I should ask your where Westerners should move to, considering that the whole region is like this, even in rural areas. I would like to visit different states before seriously considering relocation. It's also important to consider local demographics, not just geography. But for context, why did you move to the Western mountains?

And don't think I intentionally take local opinions seriously, it's more that I am gullible and naive. And economic necessity is, I do believe, necessary for a full-fledged marriage culture. Unbounded prosperity can be detrimental to society. And women aren't marrying early anywhere I know about, early meaning under 23. I also think there is a distraction among conservatives, the pro-life movement,which takes attention away from how feminism's main opposition is happily married couples, not fetuses.

I recently made a long, detailed, sociological list of reasons people are not marrying. Everyone liked it, for accuracy, precision, and ease of reading, but it doesn'tchange anyone's mind until I can convert it into a mobile app or something. People insist that the medium is the message, but I like typing in Notepad. Should I post it here for some reviewing?

When I meet good older men who are perpetually single, which surprises me because I think many women would desire them, I realize the collapse of marriage is mostly a decline in men's status and ability to erotically arouse women. Perversion is involved, but apathy is a greater cause. Maybe my weirdest thesis is that religiosity increases interpersonal sensitivity to the other sex, rather than prudishness. I think the "religion is for prudes" meme is a slander.

"Single-payer implies that everyone gets the same quality of care and spends the same amount of money. It also sounds like only one person pays for everyone's costs. The phrasing is wrong. Many Americans prefer inequality, even if it hurts them. They would rather have a "Gold plan" to dream about, while receiving "bronze," than have that same top plan without the "Gold" name."

Yeah, Germany has a system somewhat like this. You're basically insured by the government if you earn less than 50,000euros p.a. or if you choose to be insured by a federal plan. Otherwise you can go for a private plan. Private plans are cheaper and offer you access to better doctors and services, but can get pricey if you have any conditions at all. Public plan premiums are set at a % of your pay. If you decide to go private you can never fall back to public unless you're broke. If you decide to switch plans, there's generally a huge spike in premiums. So, the insured generally get in to the plans when they're young and healthy and pay their premiums until death. Actuarial-wise this is a lot easier for insurance companies to manage costs.

All health services and products are controlled by a national price board. Doctors are cheap, but medical college is for free. England also has something similar where you can buy supplemental private insurance in order to get access to better doctors. I believe medicare has a similar concept as well. Employers are obligated to pay 50% of health premiums up to a certain amount, regardless of what plan the employee chooses.

I find this way of approaching health care takes more advantage of a market to price insurance, however you still have the government negotiating terms, quality and price on your behalf. Better than what we have in the States.

I lived in Germany for a few years and have experience with the healthcare there.

In all of the national healthcare countries, the government never pays for everything, so "single-payer" is more like "mostly-payer".

Of all money spent on healthcare, government pays around 45% in the US (Medicare, Medicaid, etc.).

In other Anglo colonies, it's closer to 70% (Canada, Australia).

In Continental Europe, 75-80%, just over 80% in the UK.

All these places still allow for private insurance to supplement what the national program does not cover, along with fully out-of-pocket expenses with no middleman of any kind.

That'll be one of the first things Trump will demystify when he starts to really move on healthcare.

"Just so you understand, folks, it's never going to be the government paying for 100% -- it'll end up somewhere around 70-80%, up from 45% now. But it'll be a lot cheaper than what we have now, with no negotiating and no collective bargaining."

I wonder how much can be done about the whole budget deficit and national debt issue. Healthcare spending is a big part of it, and every dollar counts, but I also know we spend more on many things because other countries spend less, and then claim to be better than we are, ungratefully. If we spend less on healthcare through collective bargaining, then maybe prices will fall globally. But they might rise elsewhere, with corporations seeking compensatory revenues to make up for losses here. The important thing is to not let "nationalism" mean isolationism, and a net loss for most people. I hope Trump actually, openly, consults with health care funding experts in other countries, and embarrasses the faux-nationalist establishment, who pretend to be well-educated and patriotic Americans, but don't learn anything useful when on vacation in Paris or Cancun. They are not cooperative.

Why are you so sure about GMU economists being sperged out? I thought they have stigma because they pwn mainstream academics by being more intellectually creative and plainly working harder. And their unpleasantness is not due to a lack of empathy, believe me on the difference between unusual, amoral sociopolitical preferences and diagnosable psychoemotional pathology (pathologizing sin leads to everything being a brain problem).

The case in point: Bryan Caplan laments that the local family-friendly swimming pool has a waiting list. He wants to just buy his way in, no matter the financial price he must pay, or the cost to the families kicked out to make room for academic royalty like him.

He knows people would be very angry about such "free-market" behavior. He is not socially numb or emotionally ignorant, in fact he has many nuanced blog posts, which are underrated by normal smart people because he is so... squirrely and shrewd. He is a believer in "objectivism," which means he metaeconomically owns the swimming pool, and everything in the whole world, as soon as he has more money than the present owners.

The theoretical implication, which is unusual because starting with theory is the standard approach in formal politics, is that whatever "naturally" maximizes inequality is by definition the best outcome, even if he loses or society collapses.

Calling proud finagling and savvy greed autism is unfair to gentle, generous autists. There are many more of them where I live than nearly anywhere else, and they are morally ok, probably less criminal and aggressive than normal people. Caplan's weirdness is in part due to his being a prodigy in an anti-social field, greed studies.

At least he very earnestly points out opportunities for society to reform itself to prevent abuses through corruption and cheating. He's good at that, because he would never do that himself, according to his own conscience, but his conscience allows for much more financialized selfishness than a regular religious person's conscience does.

I think his mother is a Roman Catholic, while Caplan Sr. is Jewish, forming a very rare marriage (looking at religion and ethnicity). That formative environment really appears peculiar in its offspring, but it just is what it is, a mixed blessing for society. Caplan could easily be a nice religious fanatic or trustworthy car salesman, too, if his milieu endorsed that.

The other GMU guys are more genteel, but less intellectually stimulating, so I don't know them well. They also don't dumb down their work for popular audiences nearly as much- Caplan is kind of the sexy PR bimbo of the group, presentable because he likes attention over the internet enough to make him relatable to the intended elitist audience. He's also a very classically disciplined, modernly original scholar, which is rare in post-modernity.

Only GMU renamed their law school after SCJ Antonin Scalia. So they're becoming more Italic and Roman Catholic, less WASP and Jewish, which counts as reactionary change in this country. Watch out- they treat their students well, so they will be rewarded with more than prizes. Their success might even implode the Nobel Prize in Economics- once everyone sees it's badly biased to justify market manipulation, few will applaud it anymore.

More so than other academics elsewhere?You would know, but I noticed that my community college professors were all slightly weird. And my definition of autism is at least two of the following conditions:

Probably one other reason why Boomers are obsessed with Trump is because they are older and sicker, if things go wrong they could end up shit's creek, either unable to support themselves or worse. This is especially applicable concerning the healthcare debate.

They also control most of the wealth in the country; if they things change, either because Trump is successful or because he "blows it up", they have more to lose.

The younger generations take a devil-may-care attitude, they don't have as much money or investment in the system as it is. some, even some liberals, may fantasize about Trump "blowing it up"/apocalyptic "larping".